have bureaucrats saying, just tell me what i have to do, and i'll do it. what we have in the city with the homeless outreach team and the department of public health is people asking themselves what do we need to do to have a program that works and developing programs that work. the fact that -- the thing i think i was most struck by on the entire tour was marc spoke of how in no other public health arena does a doctor tell a patient, you have to get better before i will give you services. a heart doctor doesn't tell a heart patient when your heart's better, come and see me. and the fact that we take people in who are over the tipping point, who are in the worst possible states of mental health and substance abuse and give them a place to stabilize is fantastic. marc and dr. parekh and margo are humble people, they wouldn't have said this about themselves, so i wanted to take

a minute to say thank you very much, especially marc, for your service and all you guys for your hard work. dr. parekh. >> thank you, mr. stein, for that wonderful introduction. thank you, council members, for this opportunity to share what we do on a day-to-day basis. i'm a psychiatrist with the department of public health and clinical director of the homeless outreach team. our team started about 8 years ago and under mayor newsom's leadership and mayor newsom had visited different locations around the country and had heavy belief in the fact that you need outreach to reach out to folks who are otherwise unable to connect to the services that can help them. there are lots of people who use our department of public health services, human health services, shelters, but the outreach team is composed in particular to reach out to folks who had the inability because of their disabilities to make these connections. and

so we were put together, you know, staffing from the department of public health, from human services agency, from a nonprofit, cats, one of the wonderful thing about cats is that they actually hire people who formerly were homeless, who formerly were people with substance dependence and these are folks who have now recovered and they want to give back. so our co-workers are people who have actually been through the experience themselves along with some of our psychiatric and social work perspective, this one-two punch is a great way to address the needs of people who are still suffering and having a hard time with their disabilities. we found out very quickly chasing people around the city, from corner to corner, some people liked certain areas, some people moved around, was inefficient and was difficult because we wouldn't always find folks when we needed to find them. because we were a

homeless outreach team our main goal was to get people to housing. we had this housing first model which i will talk about a little bit more later, but we wanted to get people off the streets as quickly as we could. it just so happened that one of our hsa staff members from his previous position working in shelter positions had in his back pocket something we called a stablization room. this was a room in a private sro hotel that people could stay in for a few days to a few weeks, get stabilized and use this as a jumping-off point for other things they needed to do including achieving permanent housing, mostly permanent supportive housing. we used that room for a few days at a time for each individual and we realized that really worked. now people had a place to stay, they had a place to keep their medications, they had a place we could engage with them and if they happened to not be there that particular moment we could leave a message with the

hotel clerk. we turned around and asked our bosses, our leaders in the department, hey, can we have some more of these rooms and we got 8 more. this was a time that care, not cash, had just begun and direct access to housing which is under housing urban health under marc trotz's leadership was also ramping up. so there was a lot of permanent housing coming on board and these rooms turned to be a great stepping stone to getting permanent housing. a lot of folks in the community who are chronickly homeless had all kinds of homeless, they had no id's, they had no benefits, so they needed a place they could feel safe, they needed a place they could keep their belongings without them getting stolen and there was a great starting point. over the years this model has worked pretty well and rooms have been added. today we have in 8 different

private hotels about 250 stablization rooms so the program really expanded. and one of the neat things about these rooms, we don't need to do credit checks, we don't need to do checks about people's legal histories. there are literally places that are so low threshold we can have people get in these rooms off the streets. availability is always an issue but our current case management capacity at any give religion time is about 280 beds. right now we have the number of beds more or less we need to handle the population size we do. the ability to move people instantly off the streets and therefore acknowledge their disabilities can get better day one has been incredible as a physician, as a psychiatrist. one of the things i should mention is the biggest disability issues that we see

are psychiatric disability and that includes substance dependence. a lot of the people who are out chronickly homeless are people with substance abuse. personality disorders are a big part. so the disabilities people traditionally think about certainly occur in our populations, but i think someone mentioned invisible disabilities. schizophrenia is hard to see when you just see someone but when you have a chance to see what their behavior is like, it becomes apparent, yes, this person is quite disabled. having access where people normally pass this person by and say this person looks able-bodied, why can't they get a job. why is this person, quote, mooching off the system. when you get to know these people that isn't what's going on. it is the fact people are dependent on a certain substance where if they didn't

have the substance fizz owe physiologically they wouldn't be able to get through the day. when we offered her a ram for the first time she said, no, no, this is my building, my family owns it and i'm keeping an eye on it. and of course she was in her dirty sleeping bag and was unkept. having these rooms is an important first step to people getting the help they need. we have structured it in a way people leave these rooms when they move into permanent housing. so there's no artificial time limit. we started off thinking a week, two weeks, four weeks, would be helpful. our current average stay is about 8 months. it takes about a 4 to 5 month window of time to get people their id's, to get certain benefits cleared up, get them sometimes stable enough so that

they are able to even present themselves for a housing interview in a way they are not going to get rejected but at least they are off the streets and that's really important. i'm a psychiatrist, we start people in meds while they are in these rooms, we have primary care nurse practitioner while they are in these rooms and all in all it's been a great program. i have to say i'm very proud that the department of public health in san francisco is one of the few departments in the country that actually does housing, that actually does things like stablization rooms. and we have a mantra in our department, we say housing is health care. for us, literally as a doctor if i could write a prescription, i would because that is a life-saving intervention for many people. it's really something that fills me with a lot of pride to be a part of this process and to be doing that.

so i wanted to leave enough time for questions and i also want to introduce marc trotz. i said something about housing first a while ago, this started in new york city called pathways to housing about 20 years ago. and the idea there was prior to this, let's get people ready to housing and then let's get them into housing. that never ever happened with any kind of regularity because people were so badly disabled and the idea they would get better on the streets was frankly a ludicrous idea. the national conversation shifted about two decades ago, the notion of let's get people housed first and then we'll work with them on their disabilities has been not only at local levels but also on the federal level what's been promoted and over the last 8 it 9 years, so that's what we

tried to do. and at that point, you know, the mainstream housing developers, the affordable housing producers which this town has many incredible affordable housing producers were well-known for as small a town as we are the number of good housing, affordable housing producers, they weren't at all convinced that having people who had been homeless for 10 and 15 years and who have 3 and 4 chronic health issues on top of it were appropriate for housing. so we took the step at that point of sort of putting them

off to the side and saying, okay, this isn't going to work, you don't want to house this population and we master leased a bunch of buildings. that's really how we got our start, we master leased the very first building that we did, we still is, pacific bay inn, 84 units on jones street. we were able to fill up that building with this new target population in a couple months as opposed to 5 years sort of the process of developing new housing and convincing everybody that we could house the people we were aiming to house. and then we just went on a roll from there and leased 5 other hotels in the tenderloin, names that you probably know, have visited people in and so forth, the windsor hotel, the empress, the plaza -- not the plaza, that's not master leased -- the star, the camelot, and before we knew it we had 450 units of what's now known as

housing first type housing. and it was all experiments and we i'm sure made many mistakes along the way, but we were very gratified that we were housing folks who had traditionally been not able to get housing. along the way we had some learning in terms of what it takes and what the support services really should be in the housing. and up until that point, really the notion was you just had a couple kind of case managers and everything would be okay. and that was an understandable, you know, beginning to supportive housing because it was a reaction against more institutional care so we didn't want to recreate skilled nursing facilities and so forth in the community, but as we got into it more and realized what we could also do additionally with more enhanced health care services on site, we really began to hit our stride more and really see how

you could stabilize people in housing and so then we hooked up with dr. josh bamburger, the medical director of our section. we started introducing, you know, some nursing hours within the building so we could do medication adherence, so we could do wound care and so forth, then we layered on some psychiatric care in our buildings and then we opened up a clinic in the neighborhood that the residents of supportive housing have very easy access to. so that was kind of our journey. as we worked through this, the housing development community was beginning to see that actually in fact we can support people in community-based housing this way and we sort of reconnected with them and probably maybe 8 years ago we started doing these really fabulous new buildings, which is what we -- what people want, not the new,

but the high quality housing. admittedly our master lease buildings aren't the most beautiful sites in the world and in some of them they don't have cooking facilities and don't have accessible bathrooms and so forth. they are important and we're housing 400 people in there who otherwise wouldn't have housing, but reconnecting back with the affordable housing community then allowed us it really do the kind of housing that i think is healing and helps people really relax and come home and start a life and cook and reunite with their family and so forth. so really in the last 8 or so years the buildings we've been focusing on are these studio units or one-bedroom unit apartment complexes that look and are as nice as market rate housing all over the city. some examples of that, our most recently opened building is the

richardson apartments, which is right behind this building, i love the symbolism of that, we have 120 units of chronickly homeless housing, i don't like that label but it's what it is known as, but it's housing for people who have not had any stability for many years. while we got our start talking about housing for homeless people, that's not really our, you know, our slogan any more. it's really housing for people who have been homeless, who are in levels of care that they no longer need, aren't appropriate for them, aren't the best for them, are high utilizers of health care services and if they don't get housing, as the literature shows, will be dead in their 50's. that's what this housing is about. so the richardson apartments, if you haven't seen it, is that beautiful building, i think, if i'm oriented correctly, that has that big green, lime green

column. inside it has this amazing court yard, it has tremendous accessibility and light and the units are beautiful. i'm just going to look at my chart for a second to give you an idea how many units we have. we have, like, 30-some odd sites now and with the richardson opening it's about 1300 units that we have added. now, not every building is 100 percent direct access to housing site. we have a lot of sites that are 100 units or a few sites, 100 units with 20 of the units being direct access to housing with the rest of the units being straight-on affordable housing, which is a very nice mix. 990 polk street

up at 9th and geary, owned and operated by tndc is roughly 100 or 110 units with 50 or 60 -- and these are all seniors, people over 55, actually -- of them being daas. so you have formerly homeless seniors, people who have been in laguna honda living with other folks who may still qualify for affordable housing so have more means, but also have aging issues and other service needs that the building addresses. so when we do services in these buildings it's not just exclusively to direct access to housing tenants. the access points, just to give you an idea who gets in and where we are looking for people, access into direct access to housing is through acute and psychiatric hospital,

long-term care, so laguna honda and other places, intensive case management programs that work in the community, our primary care clinics, our sobering and respite center and our fabulous street outreach program. one of our biggest clients and trusted partners. and, you know, the reason we do this and the health department is doing this is, one, because we think it's the right thing to do and we have spent so many dollars and so many years spinning our wheels with trying to help people recover, only to realize the obvious, that it's ludicrous to do it without housing. how does someone recover from chronic health issues in a shelter on the street. it's not even possible to any degree. and so that's sort of the, i

think, the bottom line where the health department is interested in doing it. and there is a financial argument about this, too, that many people have made, many national researchers and so forth with made, and there's huge studies that come out of new york city and upenn and so forth that demonstrate over and over again it doesn't cost any more to house someone in supportive housing than to leave them homeless when you factor in the hospital care costs, the ambulance costs, the jail time costs and so forth. and those aren't easy things to just neatly unravel and get the jail to start giving us all their money and the hospital to start giving us all their money. it's not as simple as it sounds but when you do look at that, that is the fact that in many cases it doesn't cost any more to house someone decently in housing than to leave them homeless. and if you just look at what our

average cost per month to house someone in supportive housing, it's about $1500, and that equals -- that's one month in supportive housing, or two days at san francisco general hospital inpatient, less than one day in the icu, 3 visits to the ed, and 5 days in residential drug treatment. and in many of these places, well in almost all of those, even when you do incur all those costs, the person is still homeless afterwards. it's not like, okay, we have them in icu for 3 days, we're all set, they have somewhere to go. so really what we see and what a lot of the effort of the health department is to tray to intervene in that, you know, really harmful to the client and expensive ricocheting through the system and never really landing anywhere. some of the other sites, it

works better when you are showing them up on the screen but we're just going to have to visualize for a second here. in case you've seen them and wondered about them, these are more recent sites i'm pointing out like in 2010 the 149 mason street site, it's owned by glide, it's got that ceramic mural on it. 55 units, beautiful housing right on the edge of union square. so people come out of their apartments, hopefully they head that way towards union square versus the other way towards the tenderloin and they can sit and enjoy san francisco just like everybody else does. other, you know, sites that we're particularly proud of, edith whit senior community is a direct access to housing site right there on 9th and mission street. it's 107 units, 27 of them are direct access to

housing. the reimagine coronet theater which is now housing on gary street, big housing complex, a proportion of those are direct access to housing. armstrong in bayview, it's 116 units, 23 of which are direct access to housing. and our blockbuster that's in the pipeline right now is the ymca at 220 golden gate. almost everybody in san francisco has done something in that building since the early 1900's. a lot is basketball, some is dropping people off at the children's center that was there forever, and so forth. and this is going to be by far the largest

supportive housing that the city's ever done. it's also, i think, one of the most impressive and interesting buildings. it's going to be opening at the end of this year. it's a 6-year project, it's a 90 million dollar project so i think that says a little something about the city's commitment to supportive housing. it's going to be 172 studio units, fully accessible all throughout the building. it's going to have an 11,700 square foot health clinic, the department of public health health clinic on the ground floor. it has a full court gym on the fifth floor that we're keeping because physical activity and wellness and space to just be is at such a premium in the tenderloin, we didn't want to get rid of that. everyone thought we should cram more housing units into that space and we thought, no, we need this recreation space. so we have that. it has a

200-plus seat historic auditorium that the community can use. many people know that auditorium, wait till you see it again now that it's been restored back to its original historic look. it's quite something. and full complement of support services for the tenants who are living there. so the health clinic is a community health clinic and then it's also going to have the support services for the 172 residents up on the second floor around this kind of light court. it's really something. i think we're all really proud to have been a part of it. tndc is the owner with a lot of coordination and collaboration with the department of public health, the mayor's office of housing, tons of state and federal agencies are part of

that mix. and really that, i think, is the direction, you know, we want to be going. you can't always come across a building of this scale but the building will be very alive, very vibrant, there's a lot of con gregant space where people can hang out and get coffee. a lot of this is about helping people not just get housing but have a life and have neighbors and friends and i think this building is going to provide a lot of that. it did have a pool, which i really wanted to keep, but we weren't able to in the ground floor. it's now this humongus space -- no, it's a preserved pool. some day the covering will be taken off and the art

deco pool will be found, short of being able to keep it there as another recreational opportunity for the people in the building, we couldn't because of the earthquake issues and safety issues and so forth. it's now, it's just huge recreation -- multi purpose room. so you could probably have a meeting of 500 down there, you know, with av and all of this kind of stuff. so the whole thing i think will be quite a resource for the central city area. and that's what we're really up to. we've got about another four or five hundred units in the pipeline, including this really fantastic unit that will be springing up soon or starting to spring up in the new transbay area. the first building to come up in the area of the demolished transbay terminal and the housing area

is a direct access to housing site, another 120-unit site, owned and operated by the agency that ownd richardson so it should look every bit as nice as richardson and the services should be every bit as good, and some other buildings sprinkled throughout. so that's what we're up to. i hope and i know that under margo's leadership and all of your advocacy that the city will continue to produce these types of sites. it's been a pleasure talking to you guys. >> thank you, marc, do we have any questions from the council? ken? >> while we're waiting for the council to weigh in if they have questions, one thing that you brought to mind that i had forgotten, just to let people know what an incredible facility richardson is, that was the one i had the pleasure

of visiting, the architect for that were the same people who did the ed roberts campus. so you know these guys aren't skimping. the other thing was that, as someone who had adult life long issues with environmental concerns, to see that nobody had to tell them to do non-voc stuff, two years ago i didn't even know there was carpeting that didn't off gas and they have it in little squares so if there's a problem they don't have it reduce the whole carpet, they just replace the square. that's the kind of attention to hidden disabilities that i appreciate myself. >> harriet. >> hi, good afternoon, thank you, mr. marc trotz and dr. raj

parekh. you said no id's were required. i'm wondering since the people are from different backgrounds, different history, different medical needs, how do you prevent harm to another client and would there be like a resident advisor in the same building or on the same floor and especially in these older units also would there be elevators and any type of security? >> well, we can answer from both of our perspectives. in the housing, all the sites have 24 hour desk clerking and especially in neighborhoods where we feel like the straet activity would require that.